- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,398.83
| Facility | | $1,096.48 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $512.86 / $831.76
| Professional | | $288.40 | $512.86 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $3,388.44 / $4,570.88
| Facility | | $2,818.38 | $3,388.44 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $436.52 / $660.69
| Professional | | $309.03 | $436.52 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $398.11 / $912.01
| Professional | | $281.84 | $398.11 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $3,019.95 / $4,365.16
| Facility | | $831.76 | $3,019.95 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $371.54 / $616.60
| Professional | | $269.15 | $371.54 | $616.60 |